METHOD FOR SURGICAL RECONSTRUCTION OF PELVIC FLOOR IN POST-HYSTERECTOMICAL ABLATION OF THE VAGINAL CANOPY Russian patent published in 2018 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology, gynecology and proctology. Monophilic macroporous polypropylene mesh endoprosthesis ribbon with atraumatic edges is installed through vaginal access by bilateral fixation of the above-mentioned endoprosthesis tape to the sacro-osteous ligaments of the small pelvis with subsequent fixation of the dome of the vagina with bioinertal threads to the indicated endoprosthesis-tape and the reconstruction of the endopelvic fascia. In order to install this endoprosthesis tape, access is made through the most prolific area of the vaginal canopy, after which through the incisions, performed on the skin of the perianal region under the ischial tuber at 4 and 8 hours in the middle of the distance between the coccyx and the external sphincter of the anal opening, 5 cm lateral to latter conduct a curved metal conductor. Distal part of the conductor is made in the form of a pin, with a tunnel on it, which is a symmetrical single-row metal spiral, which is wound in a turn to the turn, with a diameter of 1 mm larger than the diameter of the conductor and covered with a polypropylene sheath outside. Conduct a metal conductor into the sciatic and rectal space through the sacro-spine ligaments “from the outside to the inside” with the removal of the tunnel into the zone of access. Then, through the installed tunneler, the aforementioned endoprosthesis-ribbon is carried out with the removal of its distal ends onto the skin of the perianal region, then two fixing non-absorbable filaments are made bilaterally at a distance of 1.5–2.0 cm from each other through the central part of the above-mentioned endoprosthesis-tape. Subfascially suture seam is applied to the inner surface of the endopelvic fascia by absorbable filaments, so that the lateral stitches of the seam pass above the fixation of the aforementioned endoprosthesis ribbon with threads directed at 3 and 9 o'clock of the conventional dial, grasping them in the suture seam and then tightening it. After this, the fixing endoprosthesis-tape strings are connected with each other. In particular case with pronounced atrophy of the vaginal mucosa after binding of the fixing non-absorbing filaments to each other on the inner surface of the endopelvic fascia, the suture seam is repeated with the capture of the above-mentioned fixing threads, which is tightened and then the fixing threads are connected together.

EFFECT: method allows to simplify the technique of the operation; reduce trauma and reduce its duration to reduce the amount of intraoperative blood loss, reduce the risk of damage to the pelvic organs, development of constipation and chronic pain syndrome, relapse of prolapse, extrusion of suture material, erosion of the vaginal mucosa and dyspareunia.

1 cl, 1 ex